Dialysis Study Sees at For-Profit Chains

For-profit dialysis clinics have higher death rates than those operated by a nonprofit chain, according to a new report from ProPublica. The report is based on a study of dialysis clinics that was conducted by the Medical Technology & Practice Patterns Institute (MTPPI) and published this week in the journal Health Services Research.

Close to 400,000 Americans receive dialysis, with most undergoing three treatments per week at outpatient clinics. According to an earlier ProPublica investigation, kidney dialysis became common in the US as a result of a 1972 law that mandated Medicare coverage for almost all patients who depended on the procedure. Medicare has long favored large companies because of their ability to hold down the cost of dialysis.

More than 80 percent of American dialysis clinics are run for profit, according to ProPublica. Two for-profit companies, Fresenius Medical Care North America and DaVita Inc, control the market. The MTPPI study does not name the chains involved, but according to ProPublica, Fresenius and DaVita ranked first and second in number of clinics in 2004, when the research began.

The MTPPI study followed 34,900 Medicare patients for two years who started dialysis in 2004 at 3,601 free-standing clinics. It compared the five largest dialysis chains (four for-profits and one nonprofit), as well as nonchain clinics.

According to ProPublica, patients treated at the largest for-profit dialysis chain had a 19 percent higher risk of death than those treated by the nonprofit. The death rate was 24 percent higher than the nonprofit at the second largest for-profit dialysis chain. The study also found that patients had a 13 percent lower mortality risk if they were treated at nonprofit clinics, regardless of chain ownership, than if they received care at for-profit clinics, ProPublica said.

In addition, patients at the nonprofit chain had the shortest hospital stays and were most likely to be in the recommended range for anemia, despite being given the lowest doses of anemia-treatment drugs. The nonprofit chain also had more nurses on staff compared to unlicensed, lower paid patient-care technicians, ProPublica said.